Alex Brecher

The West has already seen scorching weather, with temperatures reaching the triple digits, and the rest of the country is sure to see some heat waves soon. In summer, dehydration can sneak up on you fast, leading to headaches, fatigue, and confusion. Dehydration can also stall weight loss because water helps reduce hunger. When you need to drink more water, your body can mistake thirst for hunger, causing you to eat more than you need. Basic Guidelines for Meeting Fluid Needs after Weight Loss Surgery On a normal day, you need at least 64 ounces, or 8 8-ounce cups, of fluid per day. When the weather is hot, dry, or windy, you need more. Meeting your requirements can be challenging after weight loss surgery because you should drink fluids between meals, not with them. You need to stop drinking fluids at least 30 minutes before a meal or snack, and you should not start drinking fluids again for another 30 minutes after you finish your food. This is a sample daily schedule that can allow you to get all of the fluid you need without interfering with your meal plan. 7:00 a.m. 1 cup decaffeinated coffee 8:00 a.m. breakfast 9:00 a.m. 12 ounces (1.5 cups) water 10:00 a.m. morning snack 11:00 a.m. 1 cup low-sodium chicken broth Noon lunch 1:00 p.m. 1 cup flavored water 2:00 p.m. 1 cup water 3:00 p.m. afternoon snack 4:00 p.m. 12 ounces (1.5 cups) unsweetened, decaffeinated iced tea 5:00 p.m. dinner 7:00 p.m. 1 cup water If your meal plan includes only three meals a day and does not include snacks, getting your fluid needs is easier because you do not need to work in the extra snacks around your beverages. Do Not Drink Your Calories! You only get a certain limited number of calories per day if you want to lose weight. Your calories should come from nutritious foods, such as lean proteins, vegetables, fruits, and a small amount of starches and unsaturated fats. These healthy foods can help reduce hunger as you lose weight. Choosing to get your calories from liquids instead is called “drinking your calories.” It is a problem because liquid calories are not very filling compared to solid foods, and you can easily take in more calories than you realize if you drink your calories. For the number of calories in a 20-ounce bottle of soda, you could have a 3-ounce portion of chicken breast, a half-cup of cooked pasta, and a half-cup of steamed vegetables. You should really only get substantial amounts of calories from liquids right after weight loss surgery, when you are on a liquid or pureed foods diet and cannot meet your nutrient requirements from foods. Otherwise, if you drink beverages with calories, you can gain weight or stop losing weight in a hurry. The following beverages have about 100 or more calories per 1-cup (8-ounce) serving). Milk Fruit juice Regular soft drinks and fruit drinks Energy drinks Sweetened iced tea Milk-based coffee beverages or coffee beverages with flavor syrups What About Milk and Juice? Milk and juice are both nutritious, but they do not belong in your regular weight loss surgery diet. Fortified milk provides 9 grams of protein per cup and is a great source of calcium and vitamin D, but it contains 90 calories per cup. Fat-free yogurt and low-fat cheese are better choices for your protein and calcium because they are solid foods. Milk is only a good regular choice when you are recovering from surgery and are on your liquid or pureed foods diet. 100 percent fruit juice can be high in potassium and vitamin C, but it is protein-free and high in sugars. Because of its sugar content, juice can lead to dumping syndrome. Shortly after surgery, your surgeon may allow a half-cup of juice diluted with water, but when you get to the solid foods stage of your weight loss surgery diet, juice is not allowed. I Can’t Tolerate Water! One of the common side effects of weight loss surgery is that your tastes change. Unfortunately, sometimes that means that you no longer enjoy drinking water. If you are having trouble getting down your water, these suggestions may help. Drink ice water instead of cool water – this can really make a difference. Place a slice of lemon or lime on the rim of your water glass. Squeeze lemon or lime juice into your water and add a packet of calorie-free sweetener. Try a calorie-free, non-carbonated flavored water. Place some leaves of mint in boiling hot water and let them steep. Drink your mint tea hot or put it in the fridge so you can have refreshingly cold mint tea later. Keep trying. In all likelihood, you will eventually be able to tolerate water again. What about Coffee and Tea? Some coffee and tea beverages are clearly out of the question, unless you’re ready to spend 200 or more calories on a sweetened coffee drink or tea. The caffeine is also a problem for weight loss surgery patients, since it can irritate the stomach. Finally, too much coffee or tea can interfere with the absorption of certain key nutrients, such as iron. If you do drink coffee and tea, limit yourself to 2 cups of decaffeinated coffee or tea per day. Skip the Alcohol Alcoholic beverages can be some of your biggest saboteurs after weight loss surgery. It is not just that alcohol helps to dehydrate you. Alcoholic beverages can be frighteningly high in calories. For example, a 5-ounce glass of red wine has 127 calories, a 12-ounce can or bottle of beer has 145 calories, and a 1.5-ounce shot of rum has 96 calories, and a 3.3-ounce margarita has 153 calories. The damage goes beyond the calories in your drinks, though. Alcohol relaxes you. When you drink, you tend to lower your inhibitions. That means that you are less likely to measure your foods, stick to small portions, and pass up the high-calorie temptations. You're more likely to overeat, and regret your alcohol and food intake later. Have a great summer and stay hydrated, safe, and healthy!

Traditionally, society has treated obesity as a choice. If you have been struggling with obesity for years, you have undoubtedly come across many people who believe that they believe that you have consciously decided to become and remain overweight. They let you know, tactfully or less discreetly, that they have no sympathy for you. However, obesity is a disease that requires as much attention as any other medical condition. % Of Obese Americans Keeps Growing Every Year The CDC, Center for Disease Control, reports the state averages for the percentage of Americans who are obese by year: The American Medical Association’s Designation of Obesity as a Disease The American Medical Association (AMA) officially classified obesity as a disease in June of 2013, describing it as a “multi-metabolic and hormonal disease state.” It was already common knowledge that obesity leads to unhealthy metabolic and hormonal changes, so this new classification may seem at first glance like a question of semantics that is relevant only to academics and scientists. When you dig a little deeper, though, it seems as though this decision can actually have far-reaching effects in the nation’s fight against obesity and in your own life. Why Obesity is a Disease In addition to the AMA, the World Health Organization (WHO), Food and Drug Administration (FDA), National Heart, Lung, and Blood Institute (NHLBI), and other respected organizations recognize obesity as a disease. It impairs normal body functioning. It has a set of characteristic signs and symptoms. It decreases life expectancy. It can lead to harmful conditions, such as type 2 diabetes and hypertension. It can be a genetic disorder. Benefits for Society of Recognizing Obesity as a Disease An important benefit of classifying obesity as a disease is the increased awareness. An organization as respected as the AMA is calling the nation’s attention to the fact that obesity rates are alarmingly high and increasing. The AMA is also drawing attention to the wide-ranging set of causes of and treatments for obesity. Policymakers are more likely to support community public health approaches for fighting obesity. They might promote obesity education in schools and provide funding for obesity research. Weight loss drugs could receive more scrutiny and faster approval if they are seen as necessary to fight a disease rather than unnecessary products that encourage consumers to continue unhealthy, obesity-promoting behaviors. How Your Health Care Might Improve The benefits of having obesity seen as a disease can hit closer to home, too. Doctors are more likely to address obesity and work with you to fight it when obesity is considered a disease. They might pay you more respect as society moves away from the current model of finger-pointing when it comes to obesity. Also, since obesity is a disease that can be treated, it is the role of health insurance companies to pave the way for you to seek treatment. Insurance companies are more likely to provide coverage for obesity treatments from lifestyle counseling to weight loss drugs to weight loss surgery. Until now, insurance companies have rarely supported reimbursement for diet counseling and psychotherapy as an obesity treatment, and only some plans provide coverage for weight loss surgery. Often, they only allow certain types of weight loss surgery, and have more stringent requirements. The Psychological Benefits of a Label Finally, there can be psychological benefits when obesity is recognized as a disease. The stigma around obesity, seen in the workplace, on the streets, and maybe even in your own family, may decrease now that there is official recognition. Like HIV/AIDS and depression have already become, obesity may eventually become an accepted condition that deserves compassion and requires medical attention and support rather than a condition to be ashamed of. The designation is a validation of the struggles you currently face and may have faced for years or your entire life. It can be infuriating when others judge your obesity as a choice or lack of willpower. Worse, these descriptions can be discouraging, and prevent you from having the strength or even wanting to continue to fight obesity. An official diagnosis of obesity lets you know that you have a specific battle to fight, and the medical field is in your corner. This can give you confidence to make tough lifestyle changes or life-changing decisions such as weight loss surgery. You Still Need to Treat It What would you do if you were diagnosed with pneumonia? You would not just ignore it. You would discuss your treatment options with your doctor, and follow his or her recommendations. You would get chest x-rays, lab tests, and lung fluid samples to help in determining the nature of your condition. You would aggressively treat it with antibiotics, other medications, hospitalization, and plenty of rest and fluids. High blood pressure, diabetes, cancer, and depression are just a few other conditions that you would not think twice about treating. Similarly, a diagnosis of obesity is not a green light to ignore it, but research described in the New York Times suggests that this is exactly what is happening in some cases. In one study, individuals who were told that their obesity was a disease ended up choosing higher-calorie foods than individuals who were not told that they had a disease. That is, individuals who were told that they had a disease called obesity felt that they were victims of a condition beyond their control, and that there was no point in fighting it. The point is that you need to address obesity, whether it is a disease or not. Not everyone will be able to use the same strategy to successfully lose weight and keep it off, but one or more approaches can work for you, whether they are specific dietary changes, exercise, weight loss surgery, or a combination of these.

A common concern among people who are trying to lose weight is the cost of your lifestyle change. If you are trying to decide whether weight loss surgery is for you, you might be worried about the cost of the procedure. If you have had weight loss surgery but are struggling to lose weight, you might be having trouble justifying the cost of your healthy diet. While it is true that you will have to pay more for certain things, such as the upfront cost of surgery and the cost of healthy foods, it is also true that by getting healthy, you can save plenty of money on long-term healthcare costs and other expenses. How Much Does Obesity Cost? The answer is not simple when you consider the current and future costs of medications and other medical care for obesity and related conditions. Many obese individuals are taking medications to lower cholesterol and blood pressure and to manage diabetes. You can easily be spending hundreds of dollars a month on your prescription drug regimen. Blood tests are another expense that you probably regularly need to purchase in order to monitor your cholesterol, blood sugar, and triglyceride level. Even with insurance, you might be paying substantial amounts until you hit your maximum out-of-pocket level. You also need to think about the possible costs down the road. These can include major expenses, such as the cost of knee or hip surgery to relieve osteoarthritis pain, a hospital stay for a heart attack or stroke, or dialysis because of kidney failure resulting from complications of diabetes. Obesity is not guaranteed to cause all of these in every individual, but it does increase your risk. Of course, you are also paying for obesity if you take more sick days than you otherwise would, or if you are unable to accept promotions or switch job because you cannot meet the job demands. Do Not Forget the Cost of Temporary Weight Solutions If you are even thinking about weight loss surgery, it is because you have already tried – without success – to lose weight. You might have been unable to lose weight on any diet plan, or you might have been able to lose weight at the beginning, but you gained it back within months or years. Whether you were unable to lose weight at all or were unable to keep it off, you have undoubtedly tried numerous diet programs. They are not cheap. You need to pay for the cost of prepared foods or special diet shakes or supplements. Some diet programs also charge for their support as well as for each pound that you lose. Hundreds of dollars over the course of years puts a serious dent in your budget, especially if you The True Cost of Unhealthy vs. Healthy Food At many fast food restaurants, five dollars can buy you some sort of value meal with a burger, burrito, or chicken sandwich, a side, such as French fries or nachos, and a soft drink. For those same five dollars, you can purchase a can of tuna, a few servings of fresh or frozen vegetables, an apple and an entire loaf of whole-wheat bread. Even if you want to eat lunch at a fast food restaurant after weight loss surgery, you can buy a salad with chicken breast or a small taco or grilled chicken sandwich for those five dollars. The unhealthy value meal can have over 1,000 calories, while the other options might have only a few hundred. While you might not be getting as many calories for those same five dollars when you make the healthy choices, you are still spending the same amount of money (or less) and meeting your needs for that same meal. Get out of the mindset of trying to get the most food per dollar, and get into the mindset of making the best choice for your money. Are the Costs of Weight Loss Surgery and a Healthy Lifestyle Worthwhile? The weight loss surgery procedure itself can cost several thousand dollars without insurance, and that may not include the cost of medical tests before and after surgery, follow-up visits, and any additional care that may be necessary in the case of complications related to surgery. You also need to buy healthy foods. Lean sources of protein, such as chicken and turkey breast, cheese, tuna and extra lean ground beef, are no longer optional. You also need to buy vegetables, fruits, and whole grains. These can seem expensive, but compare them to what you used to buy. As an example, if you are a man who weighed 260 pounds and exercised lightly a couple of times per week, you needed 2,500 calories per day simply to maintain your weight before surgery – and if you were gaining weight, you were eating more than 2,500 calories per day. After weight loss surgery, your calorie consumption is closer to half that amount. Eating half the calories lets you select nutritious foods while keeping your total costs low. Another cost of a healthy lifestyle is staying active. A gym membership can be a few hundred dollars a year, but you do not need to join a gym to get fit. Throw on a pair of sturdy walking shoes and some comfortable clothes, and you can be pounding the pavement for under $100. Consider the Intangibles Life is not all about dollars and cents. It is about living. As an obese individual, you might be missing out on a lot of life. You might not be able to spend the day on your feet when you go out with friends and family, shopping for clothes might be a humiliating experience, and fitting into an airplane seat or restaurant booth might be impossible. On top of all that, your life expectancy is lower if you are obese. Seeing your children graduate from college or being able to take care of the grandchildren is a privilege that has no cost. Bottom Line: Do Weight Loss and Health Fit into Your Budget? Weight loss surgery is not for everyone, and surgery and a nutritious diet can be large upfront costs. However, you are likely to gain the money back, along with a better quality of life, if you are successfully able to lose weight for good. Because of lower healthcare costs, better attendance at work, and the ability to do more fun activities, weight loss and health can surely fit into your budget.

When the snow melts and the sun comes out after a long winter, spring cleaning is a natural ritual for most of us. Almost all of us feel more energized when the air is fresh, new leaves appear, and birds are chirping. Spring cleaning your house lets you get rid of the dustiness of winter and give you the feeling of a new start. Did you realize that whether you are before or after weight loss surgery, your health and weight can benefit from cleaning your house? And what if you could apply your spring-time energy to cleaning up other aspects of your life, and in doing so, improve your weight loss? You can! Keep reading to find out how you can live a cleaner lifestyle and give yourself a boost in the meantime. A bit of tidying up can help keep your weight loss on track, or help you break a plateau if you’ve been stuck for a while. Spring Clean Your House A large part of having cleaner home is about peace of mind and lower stress levels. Having less stress helps reduce hunger and lets you make better diet decisions. Beyond this, a clean home lets you be more efficient because you know where things are and you do not have to wade through piles of useless things. Housecleaning also burns calories, so it’s a good thing for weight loss! Sweeping, raking, washing windows and floors, and scrubbing counters all get you moving and promote weight loss. As you clean, don’t forget to clean your closets. It is an excellent time to get rid of the oversized clothes that you plan to never be able to wear again. Seeing your progress can be extremely motivating, and removing these clothes makes room for new, smaller sizes that you will need to buy as you continue to lose weight. Spring Clean Your Diet You lose weight fastest when your diet is spic and span, and part of your spring cleaning should focus on your diet. Look carefully at whether your diet is as clean as it needs to be to stay healthy and lose weight. Are you measuring each bite? Are you choosing protein and vegetables first, and avoiding sugary foods that will make you sick? It’s far easier to follow your weight loss surgery diet plan when your kitchen is set up well. Get rid of any tempting junk foods that have snuck into your pantry and refrigerator, and stock up on healthy foods, such as tuna, vegetables, turkey, chicken breast, fruit and eggs. Dig out your food scale and measuring spoons from under the clutter, and use them consistently. Spring Clean Your Commute A nice side benefit of cleaning up your lifestyle is being able to help the environment. You can reduce air pollution and noise pollution by walking or biking whenever you can. If you are lucky enough to live near to your workplace, you may be able to walk or bike to work. If that’s not practical for you, you can still walk more and drive less. Take a healthy lunch to work instead of driving to pick something up from a restaurant at lunch time. On weekends, challenge yourself to drive less. Park further away from destinations, and walk the final few blocks instead of driving. Driving is so ingrained in us that sometimes we don’t even realize that we could walk. Try to get in the habit of asking yourself whether you can walk from your home. If not, consider whether you can park in a central location and do several nearby errands on foot. You might be able to park in a supermarket parking lot to do your food shopping, and walk to the library, post office, or other stores without moving the car. Each half-mile that you walk burns about 50 calories. Of course, if you do take the car to drop off and pick up your children, turn the engine off to reduce air pollution. Then get out of the car and give yourself a workout by walking until your children are ready to come home. Spring Clean Your Schedule Lack of time is a common excuse for all sorts of unhealthy behaviors. You might opt for fast food because you have no time to purchase and prepare healthy foods. You might not get enough protein during the day because you are too busy preparing your children’s lunch to focus on yourself in the morning. Maybe you regularly skip workouts because you do not have time to exercise. You may overeat because you do not have time to measure portions. And, whether or not you realize it, you may be cranky because you are too busy. That stops now. Take a hard look at your daily and weekly schedule, and clean it up if necessary. There may be several ways to tidy up your schedule so that you can fit in the healthy behaviors that will help you lose weight. Search your daily schedule for wasted minutes. They add up! How much time do you spend texting your family and friends and updating your social media profiles online? We’re not suggesting that you stop these activities, but being aware of them can help you weed out the non-essential parts. Skip the television occasionally. Instead of watching a 30-minute television program, go for a walk. Or, instead of walking it from the couch, hit the treadmill or do some calisthenics while you watch. Multi-task to save time. For example, you don’t have to sit down to talk to your children about their days. Talk to them while you’re in the kitchen making dinner together or you’re taking a walk. Get better sleep. Sleep in a dark, quiet, cool room to get better sleep and wake up more refreshed after less time. Spring is a time of new chances, and this spring, you can clean up your entire lifestyle to feel better and lose more weight. All it takes is a close examination of some of the different areas of your life, and you will feel better about your weight loss surgery journey.

Great article, Irene! Thanks for posting.

All people meet it at some point in their weight loss journey. It might come after you experience complications from surgery, or when you travel for vacation, or when you are unusually stressed at work. It might even come when you least expect it, when your diet and weight loss have been going smoothly for months. “It” is the dreaded plateau. How Do You Know When You Hit a Plateau? Simply enough, a plateau is when you stop losing weight even though you want to. It’s not just a day or two without weight loss. It’s a period of a few weeks or more when you keep trying to lose weight, but the scale does not budge. You think you are doing everything you can and should be doing to lose weight, but still you do not see results. That is a plateau. It can be frustrating and discouraging and seem to be unfair. Stay Positive Plateaus can be maddening, but the absolute worst thing you can do during a plateau is to give up. If you decide that your diet is not worth the effort, you are almost certainly going to gain weight. Going back to your old, pre-surgery diet habits, taking oversized portions, and eating high-fat, high-sugary foods will not just make you gain weight. These bad habits can erase your health gains. Worse, they could cause some of the weight loss surgery complications that you already know about, such as the following: Stretching of the sleeve in vertical sleeve gastrectomy Dumping syndrome in gastric bypass Esophagitis with the adjustable gastric band (lap-band) Feeling nauseous or having diarrhea Another reason to stay positive is to keep up your motivation to continue all of the other healthy behaviors in your lifestyle. Don’t fall into the trap of “all-or-nothing,” in which you decide to give up all of your healthy efforts just because your weight loss isn’t quite what you want it to be. These include: Taking your daily vitamin and mineral supplements Getting enough protein and fluids each day Following your regularly exercise routine It Could Be Worse And it will be worse if you give up. It may sound strange, but you can stay positive by thinking about how much better your weight is now than where it could be if you gave up trying. If your careful diet is not leading to the weight loss you had hoped for, it is still preventing weight gain. If you give up, you will gain weight, and probably be pretty disappointed in yourself. Measure Success in Other Ways Another way to stay positive is to stop focusing on the scale. Find other ways to measure your progress. Tracking your body measurements, for example, can let you know that you are shrinking and building muscle even if your total weight is not decreasing right now. Tracking behaviors instead of measurements is another strategy. For example, you assess your success according to whether you eat well, such as hitting your protein goals or sticking to your planned menu. Other successful behaviors to be proud of yourself for are planning and preparing meals ahead of time and making sure you drink enough fluids at times other than meal times. Be Honest and Go Back to the Basics “Why me?” That’s a natural question when you hit a plateau, but most people don’t ask it seriously. However, if you think seriously about what is causing the plateau and how you can fix it, this question can actually help you break through the barrier and get back to losing weight. In many cases, you can figure out “why me” by asking yourself these questions. “Am I logging every single bite that goes into my mouth?” “Am I following the meal plan my nutritionist or surgeon gave me?” “Am I measuring – not eyeballing – all of the foods I eat?” “Am I exercising as much as I am supposed to be?” “Am I getting in my protein each day?” “Have I been too busy or preoccupied to plan my meals and snacks in advance?” If you answer these questions honestly, you might discover that you have slipped up and are not keeping up your good habits quite as well as you thought you had. Go back to the basics of meal planning and nutritious eating, and you are almost sure to see the scale move again within weeks. You’re in Charge! Plateaus are frustrating and nobody wants to experience them at some point, but almost everyone does. These steps can help you when you notice that you are in a plateau. Stay positive and keep up your healthy behaviors. Focus on other measures of success besides the scale. Assess your diet honestly. Make any necessary changes. You can get over your plateau, and you will be stronger for it! Just be patient and do what you know is right for your health.

Weight loss surgery is difficult, to say the least. The operation takes place after years or a lifetime of being obese and after months of research and preparation. Recovery can be anywhere from “not too bad” to riddled with complications. Nearly every aspect of your lifestyle changes, from your diet to the way you look to your relationships to your mental state. The entire experience is long and challenging, no matter how rewarding. BariatricPal recognizes the challenges of being in the weight loss surgery community. You need every bit of support and information you can get to choose the best surgery for yourself, prepare for surgery, lose weight, and get healthy for the long term. The peer-to-peer support that BariatricPal members provide can be among the most powerful tools you have to help you achieve your goals. So please, help build the community up instead of tearing it down. Potential for a Powerful, Unified Community Our weight loss surgery communities began as WLSBoards, with four separate forums: LapBandTalk, VerticalSleeveTalk, RNYTalk, and SleevePlicationTalk. Each forum was dedicated to a single type of weight loss surgery. Members could discuss surgeons, diets, complications, and anything else related to weight loss surgery in general or the specific type of weight loss surgery in particular. Then we merged the four WLSBoards to create BariatricPal, which is geared toward all types of weight loss surgery. This decision was based on the following beliefs. We are all in this together. We have the same goal of fighting obesity through weight loss surgery. The surgery types share many common characteristics and BariatricPal members can therefore benefit from having more input on topics such as the post-surgery diet progression, choosing a surgeon, ways to get more protein, and dealing with head hunger. As a single community, we have greater potential to be a unified and strong voice for weight loss surgery than we did as separate communities. Some topics are surgery-specific, and there is a need for surgery-specific subforums for certain topics such as fills for lap-band patients, experience with protein shakes for sleeve patients who may not be able to eat enough on a regular basis, and dumping syndrome for gastric bypass patients. Has BariatricPal Become a Divisive Arena? Unfortunately, BariatricPal members have had some regrettable experiences that contradict these principles. Rather than being supported, encouraged, and assisted, some members have felt attacked or belittled by other members who do not believe in their choices, whether in regards to type of surgery, food choices, or other lifestyle choices. Rude behavior, while unacceptable in any circumstance, is especially damaging in our community. It weakens our collective voice. It prevents some weight loss surgery patients and potential patients from getting the information they need. It discourages WLS patients from pursuing their healthy lifestyles. Avoid Destructive Posts Most BariatricPal members are polite, helpful, and encourage. Occasionally, though, members post inappropriate and potentially hurtful posts that put down one type of weight loss surgery or another individual’s choice. In general, a poor post is one that makes a person feel bad and does not offer any useful information. These are examples of unacceptable posts. “I didn’t even know they offered the lap-band surgery anymore because it’s so dangerous.” “Weight loss is easy with the gastric bypass surgery. The rest of us have to work harder.” “You shouldn’t be asking if you can eat that. If you even are thinking about it, you shouldn’t have gotten WLS.” It’s okay to offer your opinion, but do it kindly. If you’re not sure if your post is okay, think about it before your post. The rule of thumb is to always err on the side of caution. Think how you would act if you were face-to-face with a good friend who had an opinion with which you disagree. You would listen to his or her position, then acknowledge the reasoning for that opinion. Then you would state your opinion and explain why you feel that way. Remember that feelings are harder to convey in written online conversations, and gentle words of advice can be interpreted harshly. What We Have to Gain (or Lose) When we all support each other, regardless of type of weight loss surgery, we have a lot to gain. Positive atmosphere where everyone feels welcome, so those who need it feel comfortable to come and ask questions Unbelievable wealth of experience and knowledge…among people who are kind enough to share it A place where open discussions can lead to brainstorming and generation of ideas and strategies for success A sense of pride that we are all here, with the same goal through the same means. Let us celebrate! When rudeness and disrespect take over, we have just as much to lose. Just think about what would happen if you had a question, asked it, and got told that your question is dumb or that you are doing something wrong in your weight loss journey. Maybe you would leave BariatricPal or, worse, you would be afraid to ask your question anywhere else because you didn’t feel comfortable anymore. Nobody deserves to be treated like that. Take a moment when you are on BariatricPal to appreciate the warm community, and think about what it means to you. The next time you post, ask yourself: are you helping to build a stronger weight loss surgery community, or are you tearing it down?

Great article, Yvonne!

Thanks!

You Choose: How Easy Do You Want Losing Weight to Be? Weight loss surgery is a substantial step in the battle to control your weight. It is proof of your long-term commitment to eating better and becoming healthier. Research clearly shows that weight loss surgery can be far more effective for significant long-term weight loss than diet and exercise, so why don’t all weight loss surgery patients achieve their goal weights after weight loss surgery? Why do some people find the journey easier than others, even though both sets of individuals are motivated to follow the weight loss surgery diet? The big losers do not necessarily have more willpower or desire. The important difference between the big losers and the re-gainers may be how easy they find the journey to be. Surprisingly, you can control a large part of how easy or hard it is to lose weight. The weight loss journey is not just about changing your digestive system through surgery. It is also about changing your entire lifestyle to facilitate weight loss. Weight Loss Surgery is a Weight Loss Tool, Not a Cure Weight loss surgery is a tool. It can make you less hungry by reducing the size of your stomach by inserting a band around your stomach (Lap-band), removing the majority of your stomach pouch (vertical sleeve gastrectomy) or folding or stapling away the majority of your stomach pouch (gastric bypass, duodenal switch, and sleeve plication). The vertical sleeve gastrectomy reduces hunger by reducing the amount of ghrelin, a hunger hormone, that your stomach produces. The gastric bypass and duodenal switch reduce nutrient absorption. All of these surgeries can help you eat less and lose weight, but none of these surgeries are fail-proof. You can “cheat” by eating high-calorie foods, drinking high-calorie beverages, drinking beverages while you eat solid foods, and eating without measuring your portions. Successful weight loss requires good choices on your part, and making good choices is easier if you focus on your entire lifestyle, not just the part of your digestive system that was changed with surgery. The Influence of Your Surroundings on Your Weight Think about this scenario. You leave home without breakfast and order a muffin and ice coffee at the drive-through on your way to work. You grab a doughnut at your morning meeting, and go out for lunch with your friends. You order the lunch special with a salad, breadstick, fettuccine alfredo and cheesecake. You nibble on some chocolates from your secretary’s desk as you make your way to the vending machine for a soda in the afternoon. You pick up a pizza on your way home because you know that there is nothing else for dinner. Now compare it to this second scenario. You wake up early to meet your friend for a walk before you get home for a breakfast of scrambled egg whites and spinach. You drive to work and have yogurt and some fruit at your morning meeting. Lunch with your coworkers consists of a green salad with canned tuna, and you have a hard-boiled egg for your afternoon snack. You are able to get dinner on the table quickly when you get home because you only need to defrost the meals that you prepared earlier in the week. Which scenario do you think you can help you lose weight? The second one, of course. So why not make it a reality? Do Your Surroundings Encourage Weight Loss or Weight Gain? You have battled your weight for years, if not for your entire life before weight loss surgery. In all likelihood, your environment was set up for you to eat. Take a good, hard look at your environment. Is it more like the first scenario or the second one described above? You have the ability to make it more like the second one. Notice the following items from the two scenarios. Exercise was automatic in the second one because you planned to meet a friend – so you couldn’t back out. Preparing your dinners ahead of time meant that you could eat quickly without going to a fast food restaurant. Packing your own snacks meant that you did not have to eat a doughnut in your morning meeting or chocolates in the afternoon. Make the “Right” Choice Automatic The fewer tough choices you have, the less likely you are to make poor decisions. Set up your environment so that the healthier actions are easier. To make healthy eating easier: Prepare plenty of meals ahead of time so that you always have a ready-to-eat, healthy option to prevent you from opting for take-out. Throw away the take-out menus that you used to store in the kitchen. The extra time it takes you to look up the phone numbers and menus online may be enough to let you come to your sense and realize that you don’t want fast food. Keep your kitchen stocked with all kinds of healthy foods, so that no matter your craving, you have a healthy answer. Do not keep unhealthy foods at home. If they are not there, you cannot eat them. Make sure that the healthy option is the default option. For example, measure your cheese and cut and wash fruits and vegetables ahead of time so that it is easier to snack on them than on cookies. Also consider these ideas: Meet your friends for walks or shopping trips instead of for meals at restaurants. Park your car a few blocks away from work so that you have no choice but to walk those few blocks again at the end of the day as you leave work. Do not drive past drive-thrus if they are too tempting. Also, do not keep money in the car, and consider removing your car’s cup holders so that eating in the car is no longer an option. All weight loss surgery patients have their own struggles. Far from being wimpy, removing these obstacles rather than fighting them is the best way to overcome them. The weight loss journey path will always have speed bumps and potholes, but it will be a lot smoother if you set up your lifestyle to promote better choices all day.

Same here!

You know that you will never hit your goal weight if you intentionally try to cheat on your diet by sneaking bites or deciding not to log certain foods. But what if you think you are doing everything right and are still not losing the weight you expect? Hidden calories may be to blame. Figure out the sources of hidden calories in your diet, and you just may have a weight loss breakthrough! Overeating is Possible after WLS You got WLS so that you could lose weight, but it is important to remember that WLS is only a tool. To lose weight, you need to use that tool properly. If you fall into the trap of thinking that WLS automatically leads to weight loss, you might never hit goal weight. As a reminder, these are how the lap-band, vertical sleeve gastrectomy (VSG), and gastric bypass can help you lose weight. Lap-band: The lap-band creates a small pouch, or stoma, to help you fill up faster so that you eat less. Vertical sleeve gastrectomy (VSG): The surgery removes most of your stomach and creates a small sleeve out of the remaining portion. The gastric sleeve restricts the volume of food you can eat and it reduces hunger by reducing the amount of ghrelin, which is a hunger hormone. Roux-en-Y gastric bypass: The surgery restricts food intake by creating a small pouch, and reduces nutrient absorption by having food from your stomach bypass much of your small intestine. Your weight loss surgery will not work for you if you cheat in these ways. You eat more frequently – and take in more calories – than your surgeon suggests without feeling the restrictive effects of the adjustable gastric band. You eat sugary, fatty high-calorie foods. The lap-band, especially, is unlikely to cause you to develop dumping syndrome. That is good because you will not get the unpleasant symptoms, but it is bad because it does not prevent you from eating sugar, starch or fat. Even with a stoma size of just 4 ounces, or a meager 1/2 cup, you could fit in 400 calories’ worth of M&M’s in with room to spare. You drink fluids when you are eating solids so that you are able to consume more at a single meal or snack. Drinking fluids while eating solid foods can also cause your stomach, sleeve or pouch to empty faster so that you get hungrier sooner. You sip on beverages that provide calories but do not fill you up. How Hidden Calories Might Be Throwing You Off What if you think you are following your weight loss surgery diet diligently? You measure your food whenever you can, you use your dietitian’s food list when you go grocery shopping, and you order chicken and vegetables when you go out to eat. You get protein at every meal, and you drink plenty of water each day. Hidden calories are the ones that creep into your diet. You might not know you are eating them, or you might think that you eat so few “extra” calories that they don’t matter in your diet. But, they do impact your weight loss. An extra 20, 50, or 100 calories here or there really affects your weight loss. Remember that a pound of body fat equals 3,500 calories. That’s an average of 500 calories per day to lose a pound a week. If you are getting hundreds of hidden calories a day, that could easily be a pound a week that you’re not losing. Where Are the Hidden Calories? Good question! They can be almost anywhere. Starches are not necessarily unhealthy, but they should only be part of your meal after you eat your protein and vegetable or fruit. Protein is the first thing you should eat at each meal and snack, but it is also a source of calories. Fatty meats and poultry with the skin can have 100 or more extra calories per 3-ounce portion compared to lean meats and chicken or turkey breast. Healthy foods can be high-calorie. A handful of nuts or dried fruit or a big spoonful of peanut butter can have 200 to 300 calories. Condiments can wreck your diet. A tablespoon of mayonnaise has 100 calories, a tablespoon of jam has 50 calories, and a tablespoon of salad dressing has 80 calories. Ketchup, teriyaki sauce, and marinades can have 15 to 20 calories per tablespoon. Restaurant foods can be tricky. Vegetables that you think are steamed can have butter in them, and chicken, fish and other proteins that you think are good choices can come in sauces with 100 or 200 calories per serving. Portion sizes can be several times what you need: a 12-ounce steak is 4 to 6 WLS-sized portions, and a 3-cup plate of pasta is 6 to 8 WLS-sized portions. o Examples of each of the below. Carbs: toast, crackers. Eat celery. Smaller pasta, more protein meatballs. o Protein. It’s a nutrient, but it’s also a source of calories. Esp. if with sugar/carbs in supplements, or hi-fat protein foods. Bacon o Healthy hi-cal foods: nuts, pb, dried fruit (fresh). Portion sizes. Avocado. o Condiments. Fatty dressings (choose low-fat), use less (use herbs), sugary o Portion sizes. MEASURE. Nibbling without measuring, eyeballing. You get 60 extra calories every time you take a piece of cheese that is the size of your thumb (1.5 ounces) instead of weighing it to make sure that it is only 1 ounce. o beverages o Restaurants: salads, fat added to “grilled” foods or steamed vegetables, beverages, “healthy” bagel instead of low-cal doughnut o Eating too frequently. Tips for if you’re starving (protein, no fluid with meal); tips to make meal smaller (if you’re eating so many meals, don’t need to be big) The Good News The good news is that small changes add up to big calorie savings. Have an ounce of low-fat cheese instead of full-fat, and save 50 calories. Have a quart of regular or sparkling water instead of a quart of a sports drink, and save 200 calories. Skip the bite of cookie dough after you finish baking for your children, and save 100 calories. Have 3 ounces of 95% lean ground beef instead of 85% lean ground beef, and save 70 calories. Rinse the spoon instead of licking it after you serve yourself peanut butter, and save 30 calories. Spread peanut butter or tuna on 3 large celery stalks instead of 6 triscuit crackers, and save 90 calories. Have one-third of a cup of pasta with your meatballs instead of a full cup, and save 120 calories. This works for exercise, too. Every little bit helps. When you walk for just an extra half-mile, or about 10 minutes, you burn 50 extra calories. Start to think about where extra calories may be coming into your diet, and see what you can do to limit them. You’ll be happier with your weight loss results!

Great article Jennifer!!

Your diet after weight loss surgery is likely to be entirely different from the eating habits that you had for years before surgery. Before surgery, junk foods, fast foods, and convenience foods may have been regular parts of your diet. After surgery and your return to solid foods, your diet should rely mostly on lean proteins, vegetables, fruits, and low-fat dairy products. A common concern for weight loss surgery patients is that healthy foods have the reputation of being expensive. You might fear that the commitment to years of healthy eating will be outside of your budget, especially if you paid for weight loss surgery out of pocket. But, you can eat healthy on a budget. Junk Food May Seem Cheaper at First Your pre-surgery eating habits may seem cheap. For $1, you can order a burger, taco, burrito, sandwich or fries from at value menu at most fast food places. Candy bars, chips, crackers, snack cakes and sodas from vending machines also cost about $1 each. For $5, you can get an entire pizza, a fast food value meal with a burger, fries, and a drink, or the workplace cafeteria’s daily lunch special with a fried chicken sandwich, onion rings or fries and a drink. Almost everywhere, ordering larger portion sizes and extra side dishes gives you bigger discounts. These options seem inexpensive at first glance. For example, if you compare the cost of a pizza to an alternative of ordering grilled chicken and a salad for lunch at a sit-down restaurant, the pizza is cheaper. Similarly, a doughnut from a convenience store is far cheaper than a fresh fruit salad from the same convenience store. However, you can make better use of your food dollar. Convert Your Pre-WLS Food Dollar into Post-WLS Nutrition Most of the foods on your diet before weight loss surgery may have been relatively inexpensive, but the total cost may have been more than you think. Consider this sample day to see how your post-surgery diet can continue to fit within your budget. Breakfast: Before WLS ($5): coffee and a bagel with cream cheese and smoked salmon. After WLS: 2 hard-boiled eggs, a cup of cantaloupe and a slice of turkey ham ($2). Save $3. Morning Snack: Before WLS ($3): a muffin and a coffee. After WLS ($1): string cheese and a half an apple. Save $2. Lunch: Before WLS ($7): a sub sandwich, chips, and a drink. After WLS: tuna, whole-wheat crackers and a cup of cooked cauliflower ($3). Save $4. Afternoon Snack: Before WLS ($2): a soda and a bag of cookies. After WLS: peanut butter and carrot sticks ($1). Save $1. Dinner: Before WLS ($4): steak, mashed potatoes, a dinner roll with butter, a green salad, and cheesecake. After WLS: ground turkey, green beans, almonds and a half a banana ($3). Save $1. Eat In More Often Save money by preparing more of your own food and eating less often at restaurants or fast food chains. Another benefit is that you have more control over what you eat when you prepare it yourself. You can keep your homemade food simple and still have a nourishing diet. Consider these restaurant meals and home-made alternatives to try. Each of the suggested alternatives is simple to make and it is more nourishing and less costly than the restaurant choice. A sugar-sweetened, flavored coffee beverage plus a cinnamon roll versus fat-free yogurt and fresh or frozen fruit. A burger, fries, and drink versus a salad with lettuce, grilled chicken breast and pecans. Breadsticks and a dip, soup, and fettuccine Alfredo versus broiled salmon with steamed spinach. Soda, an alcoholic beverage, or another beverage versus water. Shopping Strategies to Cut Costs and Improve Nutrition Without caution, you can spend a lot and leave the supermarket with plenty of unhealthy foods. On the other hand, a plan and some practice can help you stretch your food dollar while you stock up on healthy foods from the grocery store. Use a list. This helps you avoid impulse purchases of high-calorie, high-cost foods. It also ensures that you remember key ingredients so that you do not have to get them at the last minute from an expensive convenience store. Watch the sales. Staples in your kitchen might include tuna, peanut butter, whole-wheat pasta, beans, frozen fruits and vegetables, frozen chicken and lean beef and spices. Stock up on these non-perishables when they are on sale. Buy in bulk. Purchase larger packages, since they are usually cheaper than single-serving packages. Measure out single-portion servings when you are ready to use them. This is an especially good strategy for family-sized packs of chicken and fish, for snack products such as nuts and whole-grain crackers, and for yogurt. Buy store brands. They usually taste the same as the national brands and are far less costly. Dairy products, cereals and frozen and canned goods are good candidates. Check out your neighborhood. Discount stores and ethnic stores often have certain high-quality products for far cheaper than the chain supermarkets. Check for fresh produce, spices, and condiments at ethnic and discount stores. Buy in season. Out-of-season fruits and vegetables can be prohibitively expensive, but in-season ones can be on sale and higher quality. Some fruits and vegetables that are relatively consistent year-round are apples, cabbage, carrots, mushrooms, lettuce, onions, and celery. Your new diet after weight loss surgery requires major adjustments to your eating habits. Practice and also planning are necessary so you can get the protein and other nutrients you need, avoid the foods that are bad for you, and lose the weight you want. With so much to worry about after WLS, you do not want to have to worry about the cost of the healthy foods you need. These tips can help put you on the path to healthy eating within a reasonable budget.

The holidays are behind us, but it is not too late to consciously think about what we are grateful for. Take weight loss surgery, for example. Weight loss surgery changes almost everything. It can affect what and how much you can eat, your exercise goals, the attention you pay to your health, your daily schedule, and even your personal relationships. Achieving success after WLS means saying goodbye to pizza parties where you eat the whole pizza, trips to the drive-through for a pre-dinner meal on the way home from work, and polishing off the half-gallon of ice cream in the freezer while you watch late-night television. That can seem like a lot of sacrifice, but success depends largely on your attitude. The difference between rapid, healthy weight loss and a bumpy road filled with complications and struggle may be as simple as the difference between saying “I can’t have that” and “I get to have that.” Here are examples of changing your attitude to improve your weight loss journey. From “I Can’t” to “I Can” There are plenty of things that you can’t safely do after weight loss surgery, such as overeating, eating high-fat and high-sugar foods, and drinking alcohol without restriction. Instead of thinking “I can’t” eat that when you are at a dinner party or restaurant, think “I can” have a better time than I used to before weight loss surgery by focusing on the people instead of the food. Don’t think, “I can’t” order a large popcorn and soda while at the movie theater with my friends. Instead, think “I can” fit in the seat now and enjoy the movie! From “I Have To” to “I Get To” Some of the daily tasks after weight loss surgery can seem like tedious chores, but think of them in terms of the benefits you get. For example, measuring each serving of food can be a nuisance and is something that you “must” do, but it is also something you “get” to do to help you lose weight, learn portion sizes, and stay in control. Similarly, taking your daily vitamin and mineral supplements and monitoring your health is something that you “have to” do, but you also “get to” enjoy better energy and improved health numbers, such as blood sugar and cholesterol, when you visit the doctor. It’s not that you “have to” go to the gym; more accurately, you “get to” go to the gym to enjoy your new, healthier body and make it stronger and leaner. From “I Lost” to “I Gained” You might lose some alone or family time each day when you go to the gym, but you gain it right back in quality. When you are in shape, you can keep up with your children, spouse, and friends. The time you spend with them is higher quality than when you might have been too heavy and out of breath to do anything but sit and watch from the sidelines. And, you can say that “I lost” the chance to go to the donut shop on the way to work each morning, but it is more accurate to say that “I gained” time and money from not going to the donut store, and also the self-respect from skipping the morning sugar load. From “Never-Ending” to “Constant Progress” The post-weight loss surgery journey is long…the rest of your life! You are bound to get discouraged if you think about the journey as a “never-ending” struggle. Instead, stay motivated by looking at your constant progress. For the first year and more, your progress can include regular weight loss, smaller body measurements and smaller clothing sizes. For years afterward, progress can include improved fitness or certain athletic milestones, such as completing a 5k run. Other progress might be reduced cravings for sugar, better relationships with your family and having improved health. Eliminate Doubts One of the most important attitude shifts you can make is from being doubtful to being confident. When you know that you are going to make the right decision, you do make the right decision. When you let doubt creep in, you are far more likely to make a regrettable decision. Each day, be confident that you will make the right choices. Think about what you will do, and not whether you will do it. If it helps, attach a reason to each statement. You will go to the gym as planned because it will give you momentum for the rest of the day. You will take your healthy breakfast, lunch and snacks to work so that you can get the protein and other nutrients that you need. You will walk past the secretary’s desk without slowing to look at the chocolates so that you can feel proud of yourself as you work in your office. You will drink the amount of water that you are supposed to because it will help you lose weight, stay awake, and be less hungry. As with so many other things in life, successful weight loss depends on you following certain rules and actions. Beyond that, your attitude makes the difference between being able to make the right decisions, and making decisions that you will regret later. Will weight loss surgery be a burden to endure, or will it be a privilege to appreciate? It’s up to you…and your waistline and happiness may depend on your answer!

After weight loss surgery, you need to plan your meals ahead of time. You always want a high-protein, low-calorie option to be available at meal time. You might find yourself carrying your own prepared food with you to be sure that you have the food you need. Sandwiches are good “go-to” option, but not just any old sandwich will do! This article can help you build sandwiches that are good fits for your meal plan. What is Wrong with the Sandwiches You Used to Eat? A typical workday might have started off with a trip through the drive-through for a breakfast burrito or sandwich, or a bagel and cream cheese sandwich at work. Lunch could have been a brown bag peanut butter and jelly sandwich or a trip to a nearby restaurant for a sandwich, burrito, or burger. Where might these options leave you? Sausage, egg, and cheese croissant or biscuit from a drive-through (600 calories with 42 grams of fat) Bagel with cream cheese (500 calories with 70 grams of carbohydrates) Peanut butter and jelly sandwich (600 calories and 40 grams of sugar) Club sandwich (1,000 calories and 2,500 milligrams of sodium) Chicken patty sandwich (60 grams of carbohydrates and 1,100 milligrams of sodium) Beef, bean, and cheese burrito (900 calories and 40 grams of fat) Your breakfast and lunch sandwiches could have added up to over 1,500 calories. Add in beverages, sides (hash browns, fries or chips, anyone?), and snacks, and you could have been at 3,000 calories by lunchtime! These Choices Don’t Work After Weight Loss Surgery! Needless to say, these options do not fit into your weight loss surgery diet. First, some of those sandwiches have more calories than you are supposed to be eating in a day, not to mention that some also contain more saturated fat, sodium, and sugar than you should have in a day. Second, those sandwiches emphasize starchy breads and fatty condiments, not the lean proteins and nutritious vegetables you need to stay full and nourished after weight loss surgery. Third, they can cause complications. Doughy bagels and fried chicken, for example, can cause obstructions in lap-band patients; fatty sausage and sugary jelly can cause dumping syndrome in gastric bypass patients; and these low-nutrient foods can fill you up and cause malnutrition. Luckily, this does not mean that you need to give up the convenience of sandwiches and the pleasure you get from biting into one. There are plenty of ways to make sandwiches that are weight loss surgery-friendly: low-calorie, high-protein, convenient, and delicious! Protein Fillings for WLS Sandwiches Start by choosing a lean source of protein, just like you do when you plan all of your meals. These are some healthier options compared to what you might have chosen before weight loss surgery. Don’t forget to measure your portions if you are making your own sandwich, or eyeball your portions if you are ordering in a restaurant. 2 scrambled egg whites (30 calories) 2 ounces of canned light tuna (60 calories) 2 ounces of chicken breast, lean ham, turkey breast (80 calories) 2 ounces of fat-free cheese (90 calories) ½ cup cooked beans or 1 vegetarian burger (120 calories) 2 ounces of turkey or vegetarian bacon or breakfast sausage (130 calories) Load up on Vegetables and Fruit Vegetables and fruit are the next food groups to add to your meals. Vegetables especially are low-calorie, so add more if you want a bigger sandwich. Try classic combinations, or get creative. You can also experiment with herbs such as fresh cilantro, basil, and dill. These are some ideas. Lettuce and tomatoes with meat and cheese Grilled eggplant, zucchini, and/or bell peppers with beans Cucumbers and sprouts with fat-free feta cheese Diced celery, carrots, onions, and water chestnuts with tuna Spinach and mushrooms with egg whites Pear or apple with fat-free cheddar cheese Cantaloupe with ham and/or fat-free cheese Blueberries with egg whites Breads and Alternatives Most bread is high in carbohydrates and low in protein – clearly not what you need for your nutritious weight loss surgery diet. Besides adding calories and carbs, bread can cause obstructions in lap-band patients and make gastric bypass patients sick or overly full. When possible, skip the regular bread. Bagels Tortillas Subs Croissants Biscuits Regular sliced bread Instead, choose whole-grain, high-fiber, low-calorie breads, and consider open-faced sandwiches, with the filling on 1 slice of bread, instead of regular 2-slice sandwiches. These are some good options. Reduced-calorie bread (45 or fewer calories per slice) Light English muffin (50 calories per half) Mini whole grain bagel (60 calories per half) Low-carb tortilla (50 calories per small tortilla) High-fiber, light wrap (90 calories per wrap) Also, look for creative, non-bread alternatives. Lettuce leaves to make lettuce wraps or cups Egg roll or wonton wrappers Sheets of dried seaweed Grilled eggplant Your fork (skip the bread and just eat the filling) Keeping Condiments Under Control The condiments that you add can make or break your sandwich, both in terms of nutrition and taste. Skip the full-fat mayonnaise, dressings, dips, sour cream, and butter, and be wary of high-sugar jam, barbecue sauce, and honey mustard. Instead, consider the following condiments. Salsa Fat-free mayo, dressing, dip, or sour cream Regular mustard Plain, non-fat Greek yogurt Hot sauce Shredded fat-free parmesan cheese Reduced-calorie, trans fat-free margarine Some Breakfast Sandwich Ideas to Start Your Day Off Right Egg whites scrambled with spinach, mushrooms, and fat-free feta cheese on ½ English muffin Cottage cheese and strawberries wrapped in lettuce leaves Shredded fat-free cheese and lean ham toasted on a slice of reduced-calorie, whole-wheat bread and topped with salsa and tomatoes Egg whites cooked with turkey bacon and broccoli in a small, high-fiber wrap ½ whole-grain mini bagel spread with fat-free cream cheese and topped with canned salmon with diced celery and water chestnuts Lunch Sandwiches Lettuce wrap filled with diced chicken breast, bean sprouts, mushrooms, and bell peppers, and soy sauce or light Asian dressing Dried seaweed sheet rolled around tuna salad made with fat-free mayo, chives, and celery Pinwheels made by layering slices of turkey breast, lean ham, and fat-free cheese slices, spreading them with mustard, and rolling them Bean burrito with black beans, fat-free cheddar cheese, salsa, and fat-free sour cream on a small, high-fiber tortilla Chicken breast with sliced apple and light vinaigrette between slices of grilled eggplant Tomato sauce, fat-free mozzarella cheese, and mushrooms on a light English muffin Toasted Rueben sandwich with low-fat Swiss cheese, shredded cabbage or sauerkraut, lean corned beef, and fat-free Thousand Island dressing on a light English muffin Are You Ready for Some Sandwiches? You can eat these sandwiches at home, or make them ahead of time and carry them with you in a reusable container. As a weight loss surgery patient, you should own plenty of reusable containers with tight-fitting lids. If you do not already have some, they are worth the investment so that you can carry healthy foods with you wherever you go. We hope that you enjoy these sandwich ideas and that you are inspired to make some of your own healthy, high-protein sandwiches!

Great article!!

Your diet can be hard after weight loss surgery. You have to give up most junk food and monitor every bite that goes in your mouth. Although many patients have smaller appetites and fill up faster on less food, you can still struggle to make the dietary changes. You can be tempted to slip up, especially when food is around. And that is can be problem with family. Family food dynamics before surgery might have been a lot easier. You ate the same food, went out together, and did not think much about which foods came into the house. After surgery, you have no choice but to restrict your diet. That is why family diet dynamics change after weight loss surgery. Food Can Strain Your Family Dynamics You can have the most loving family in the world, but they may not be your best dieting buddies. They may still want to buy their favorite foods, store them at home, and eat them when they want – even if it means eating them in front of you. These are some of the risks. Caving in to these off-limit foods – and derailing your weight loss. Becoming angry at your loved one(s) – and letting food hurt your relationship. Banning all non-WLS foods from your home – and causing your loved one to be resentful. How can you avoid these losing situations? Everyone Needs to Compromise The answer is compromise. You just went through a life-changing surgery because you struggled with obesity – and food – for years. You are on a strict diet, and cannot afford to have your hard work undone because your family continues to tempt you with high-calorie food. On the other hand, members of your family may feel that they have the right to eat whatever they want, whenever and wherever they want. You can all compromise and come up with some new household rules. The following suggestions might work for your household, or you can come up with the rules that are best for your situation. Family members are permitted to eat fast food meals inside the house, but cannot store leftovers. Family members can keep certain wrapped snacks at home only if they keep them hidden from you and eat them outside the house, such as at school or work. Everyone must wrap up and put away leftover foods so that you are not tempted to grab them Everyone must respect your need to have your kitchen scale, measuring cups and spoons, and storage containers handy and available, not shoved deep into a back closet. Family Members of All Ages Contribute to the Diet Dynamics Your weight loss surgery affects everyone in your household in a different way, and everyone from young children to teenagers to your spouse contributes to the household’s diet dynamics. Modify your approach to be appropriate for each family member. Young children – They do not necessarily understand your weight loss surgery or the reasons behind it, and they are unlikely to fully understand why the household’s diet is changing. Luckily, young children are likely to eat what you offer. Offer them the same healthy foods – lean proteins, fruits, vegetables, and nutritious starches – that you make for yourself, and you may be surprised how well they accept them, especially when you are cheerful and positive about it. In addition to serving healthy foods at home and in sack lunches, you can pack a treat for lunch so that they can enjoy it and you are not tempted to eat it. Teenagers – Teenagers want to be independent. On principle, many of them automatically seem to reject anything that you do. The truth is, though, that they often just don’t want their friends to think that they’re different. If you have teenaged children, keep plenty of healthy snacks on hand and serve healthy foods at meal times. You may be surprised at just how often they choose to “sneak in” the healthy choice instead of opting for junk food! Don’t make a big deal out of it, or the teens will go right back to choosing junk foods. To further allow teens their sense of independence, An important consideration with teenagers is that they may have their own weight concerns. They may already be overweight, or they may worry that they will one day struggle with their weight just like you did. That’s why it’s important now to allow them to develop healthy eating habits without putting pressure or rigid restrictions on them. Spouse – You spouse is happiest when you are happy. You would do anything for your spouse. So why can weight loss surgery – which you went through to help you become healthier, happier, and a more capable person – lead to so much tension? Your spouse might not completely support your surgery, especially if he or she has never had a serious weight problem. Also, your spouse may be jealous of your resolve and new lifestyle. On top of everything else, your spouse might be afraid that of losing the foods that he or she loves, either because you won’t allow them or because he or she eventually will need to accept and confront his or her own weight problem. You need to have serious discussions of all of these issues and come to an agreement, just like you do in all other parts of your relationship. Let your spouse know that you aren’t changing as a person, but that you are becoming healthier. Let your spouse know that becoming thinner and more energetic will only deepen your love. And, discuss the food. Is your spouse willing to eat what you eat? Are there some treats that your spouse can eat in front of you that you are confident that you will not eat? Family Meals Post-Weight Loss Surgery You can have pleasant, healthy family meals even after weight loss surgery. One way is to prepare and eat your own food, while serving the rest of your family what they normally eat. You can all eat together. Even though you are eating less, you will take as long to eat as they will because you need to focus on chewing thoroughly and eating slowly. These are some other suggestions for family meals. If you’re the one who makes the meals, you don’t have to make two every night. Once a week, cook your own food and refrigerate or freeze single-serving portions. Eat those at family meals, and cook for your family as usual. Have a salad bar or other serve-yourself-style meal, such as a burger bar or pasta bar. Include WLS-friendly options as well as everyone’s favorites. Everyone can choose what they want to eat. For example, at a pasta bar, you serve yourself spaghetti squash, grilled chicken, tomato sauce, and salad, while others might choose spaghetti, meat sauce, and breadsticks. Have a family treat night – can you decide that for one night, they can order in or eat junk, and you will stick to your diet? You might even be able to schedule your family’s treat night on an evening when you work late or you go out with friends so you don’t have to be around the tempting foods. Make something that’s healthy for everyone, and just serve yourself a little less or skip the starch. You have learned to love lean proteins and veggies, and your family can, too. Weight loss surgery changes a lot, from your body and mind to everything else in your life. Family diet dynamics are no different. With all of the other stress surrounding your new lifestyle, the environment surrounding food in your household can become tenser. With some understanding, communication, and compromise, you can keep everyone happy as you stay on track with your weight loss…and your family just might become healthier in the end!

You already know that social support is critical for your weight loss success. Your support network can include your family and friends, and is stronger when it includes other bariatric patients – or your peers. Bariatric support groups at hospitals and clinics let you interact with other weight loss surgery patients and individuals who are considering or preparing for weight loss surgery. Peer-to-Peer Support Works Patients who attend bariatric support group meetings after surgery are more likely to achieve their goal weights. That is why many surgeons will only agree to perform bariatric surgery after their patients promise to attend support group meetings regularly for months or years after surgery, or for life. Support groups can be motivating when you see that group members, who are just like you, are overcoming the same obstacles as you. Attending meetings can increase your focus on making healthy decisions because each meeting is a reminder that your weight loss success depends on your daily choices. Support groups can make you feel accountable to others, as well, and increase your will to succeed. Another reason why support groups work is that they provide opportunities for you to ask questions and learn from healthcare providers and others’ experiences. Online Support Can Improve Patient Outcomes Online support groups can play important roles in your success after weight loss surgery. They provide some of the social benefits as in-person support groups, and offer many additional advantages. They are convenient – Online support groups are available through your computer or smartphone. Unlike with in-person support groups, you do not have to rearrange your schedule to use online forums. You do not have to drive long distances to attend online meetings, you do not have to attend after work when you are tired, and you do not have to leave your home to drive through rain or snow. You can use online groups whenever you want and from wherever you want as long as you have an internet connection of smartphone. They are always available – With in-person support groups, medical appointments, or even phone calls to your healthcare provider, you can only get answers to your questions at set times, often during business hours or during a weekly meeting. But what happens if you are at a restaurant and you need to know what to order, or if you are feeling down and need a few words of encouragement? One option is to whip out your smartphone and consult your online peers. They can let you be more open – In-person groups can feel overwhelming if you are shy by nature or if you simply have trouble opening up about your weight loss surgery. Some people do not mind talking about dumping syndrome and diarrhea at in-person support groups, but many do feel uncomfortable. However, talking about these issues is important so you can learn how to deal with them or prevent them. Many people are more comfortable talking about sensitive issues online. Your support group can become part of your life – Some online support group sites also offer additional features, such as weight loss, body measurement, and diet tracking. Tracking is an important part of weight loss success, and should be part of your regular routine. Using an online support site that lets you track your progress helps make it easier for you to participate in discussions, since you will already be at the site. You can develop the habit of using your support group and tracking your progress at the same time. You can discover anything and everything – You might not have enough time to ask everything you want when you only have limited time at support groups or in doctor’s appointments. With online communities, you can find out as much as you want either by looking through the old conversations or starting your own. There is no limit! Choose an Online Support System that Works for You The options for online support systems are nearly limitless. How can you choose the best one for yourself? These are some general guidelines to consider as you start to narrow your choices. The community should be friendly, with official policies against rudeness. Nobody should ever be allowed to make you feel attacked or vulnerable. The support system should be large, so that you are almost sure to find the answers you need to all of your questions because members have “been there, done that.” You also want to be able to receive the in-the-moment encouragement you ask for when you are down. There are opportunities to get to know members more personally, through smaller groups, private message, and live chats. This gives you the chance to establish deep friendships and feel more committed to a healthy lifestyle. It lets you customize your experience through features like a personal profile and the ability to track progress, and maintain a photo gallery and/or blog. It is available through mobile apps, so that you can access your support system from anywhere at any time. Let your instincts guide you as you choose your online support system, and go with what makes you feel welcome and comfortable, even if it is just a gut feeling. Also remember that you are not restricted to using just one community. You might end up using two or three communities regularly. And finally, keep in mind that the best system for you might not be the best one for everyone. The important thing is that you like it. The power of online support systems should not be underestimated! They can help you lose weight, eat better, and stay healthy. Using them as part of your overall support system and weight loss surgery plan can improve your outcome and be fun as well!

We are already a week into 2014. Holiday decorations are coming down, travelers have returned home from family visits, most people have gone back to work, and children’s vacations from school are over or nearly over. Over at BariatricPal, we were thinking that it might be a good idea to take another look at those New Year’s resolutions before we all get carried away by regular daily life. Did you make the right resolutions? Are you making progress? What can you do to improve your resolutions and progress? Answering these questions can get you on track for 2014 so that by the end of the year, you can feel proud of what you have accomplished. Did You Make the Right Resolutions? A week into the New Year, you may realize that your original resolutions were not practical. It’s okay to change them. Changing your goals does not mean that you failed. It means that you are setting yourself up for success. These are some examples of a resolutions that you may now find unrealistic, why they are unrealistic, and possible ways to change them. Lose 100 pounds by 2015. You cannot always control your weight loss. Plateaus or complications might get in your way. Instead, resolve to stick to your weight loss surgery diet. The weight will come off at its own pace. Convince your spouse that weight loss surgery is the best option for you. This may not be possible because it depends on someone else to change his or her mind. Instead, resolve to be patient with your spouse and to include him or her in your weight loss surgery plans. Get skin removal surgery. This is not under your control because you do not know how much weight you will lose or whether you will be a good candidate for skin removal surgery. Instead, resolve to eat healthily and work out so that you have muscle tone, and to find out your options for cosmetic surgery. Interim Resolutions to Keep Your Progress Up This is toughest when your resolution is to achieve a specific long-term goal, such as getting weight loss surgery or going on a dream vacation. You can track your progress and stay on schedule by making interim goals. For example, one goal might be to jog a half marathon for charity while you are on a family trip in Florida in December. Maybe you set this particular goal because in December of 2013, you were not able to go on the trip because of your weight or health, because you did not plan, and because you knew deep down that you were not in good enough shape to enjoy the trip. December of 2014 seems far off now, but you may need to lose a lot of weight, do a lot of planning, and gain a lot of fitness. These sample interim goals can keep you focused and on track. January: begin a walking program. Resolve to exercise 3 times per week. February: check in with your weight loss surgery diet. Are you following your meal plan well enough to lose weight and stay healthy? March: Look for a buddy! The year is long, and you can use some motivation. Do you have a weight loss buddy to talk about food and exercise with? If you don’t have someone at home, find a BariatricPal member to be your buddy! April: Add some jogging in with your walking. May: Make a list of activities you want to be able to do on your trip, in addition to your half marathon. Resolve to keep eating right so that you will be able to enjoy them without getting tired or being left behind. June: Make sure nutrition is still your top priority. Are you getting the protein, vitamins, and minerals that you need? July: Register for the half-marathon. Look back over the first half of the year to measure your progress. Resolve to make improvements if your diet has slipped. August: Start to make reservations for your trip. Take advantage of any specials for early plane and hotel reservations. Now you are committed to this trip! September: Find and begin a half-marathon training program that will take you up until December. October: Keep training and eating right. Resolve to keep measuring your portions and eat protein first at each meal. Don’t let your good habits slip! November: Research the restaurants that you will be eating at December: Have a great half-marathon, and be proud of your hard work through 2014. Enjoy your new, fit body! In this way, you are staying motivated throughout the year to lose weight, eat healthily, and exercise. Your reward is serious weight loss en route to a dream trip celebrated with a half-marathon – an accomplishment anyone should be proud of! We encourage you to take a few moments while the New Year is still fresh to go over your resolutions and make them work for you. You will be glad you did!

Most overweight people face bias against their weights the entire time they are overweight. As an overweight school child: your classmates probably teased or shunned you. As an obese college student: you might have skipped group activities because you were not invited or you knew you would be mocked. As an obese adult: getting a job was probably more challenging, and you are probably judged daily at work and everywhere you go. Without a doubt, obesity is stigmatized. The unfair bias that you face may be a major factor in your decision to consider or get weight loss surgery. Unfortunately, you will probably find that the obesity discrimination continues even as you try to use weight loss surgery to get healthy. Obese patients are blamed for their conditions, healthcare providers are not always sympathetic, and coverage for weight loss surgery is not guaranteed. Why Do Obese Patients Get So Much Blame? People are increasingly sympathetic to diseases that used to be stigmatized. Examples include cancer, many mental health conditions, and sexually transmitted diseases such as HIV/AIDS and syphilis. Now, treatment for these and other conditions, such as diabetes, is widely accepted as normal and an entitlement. Each of these conditions is largely the result of lifestyle choices, such as diet, use of tobacco and/or alcohol, sexual behavior, and physical activity levels. More than 80% of cancers are likely the result of lifestyle choices. Ironically, though, many people in our society remain unsympathetic to obese people. They are quick to blame obese people for having no self-control, for refusing to follow a diet, and for not wanting to be healthy. You know, though, that those accusations are far from the truth. If you are considering weight loss surgery, you are confident that you have the self-control for the weight loss surgery diet, that you have tried to follow numerous diets but none have worked for you, and that you desperately want to be healthy! You Did Not Ask to Be Obese: Some Factors are Outside of Your Control More than one-third of American adults are obese, and another third are overweight. That in itself should remind you – and the people who judge you harshly – that fighting obesity is hard! The food environment includes fast food, vending machines, restaurants, food-focused social gatherings, and inexpensive snack foods. There are also biological and family factors that you cannot control. Skinny people have no idea that you may be feeling extreme hunger all day, every day, or that your metabolism may be slower. Your family might have raised to choose high-calorie, high-fat foods, or even driven you into unhealthy emotional eating. Research shows that some obese patients’ brains even respond differently to food compared to lower-weight individuals. Obese individuals, for example, tend to get less pleasure out of food, meaning they need to eat more to get satisfied. Furthermore, high-calorie foods like sugar can be addicting, leading to the same brain responses as cocaine does. But nobody blames cocaine addicts for their situations! Instead, they encourage counseling and intensive program to help them overcome their addictions, not punish them. Discrimination in Obesity Treatment: A Look at Weight Loss Surgery Versus Dialysis Just as unfair is the fact that the healthcare system continues the discrimination against obesity. Compare weight loss surgery as an obesity treatment with dialysis as a treatment for kidney failure (end-stage renal failure). Far from being blamed for their conditions, kidney failure patients who need dialysis are provided the respect that all people deserve and the medical care that they need. Dialysis patients of all ages in the United States are able to apply for Medicare, the government’s health insurance program normally reserved for older adults. Dialysis treatments can cost about $40,000 per year, not including This is not to mention human factors such as reduced quality of life (the vast majority of dialysis patients are too sick to work) and early death (the life expectancy of dialysis patients is about 5 years). In comparison, a typical weight loss surgery procedure in the United States can cost $20,000 to $40,000, although it can be less, and successful patients are healthier and have more energy than before surgery. The irony increases. The fact is that kidney failure usually results as a complication of type 2 diabetes or high blood pressure (hypertension). Both of these conditions are often caused by obesity; losing weight after weight loss surgery can prevent, eliminate, or reduce these conditions. In addition, it takes years for kidney failure to develop once you have high blood pressure or diabetes – years during which patients are likely to be on costly medications and inconvenient treatments. Targeting obesity through weight loss surgery could prevent cases of diabetes and high blood pressure, reduce their effects in people who already have them, and prevent kidney failure, the need for dialysis, and early death. Searching for Fairness in the Medical Treatment of Obesity Your first barrier in your path to weight loss surgery may be your primary care physican (PCP). Some PCPs do not know much about weight loss surgery, or may be against it because they think obesity is your fault. Some PCPs take a narrow view of obesity, and feel that the only way to lose weight is for patients to “decide they want it badly enough” and “just eat less.” You already know that doesn’t work, so don’t let your PCP discourage you from learning more weight loss surgery if you think it might be the solution to your obesity struggles. Insurance coverage has improved for obesity treatments, especially for weight loss surgery. Medicare and many private healthcare coverage plans cover weight loss surgery if you meet their predetermined weight and/or health criteria. Some private insurance companies, though, take a short-term view because they want to make profits within 3 years. Since most weight loss surgeries do not pay for themselves within 3 years, some private insurers do not cover weight loss surgery despite the likelihood that they would pay for themselves within 5 or 10 years, and in addition improve your health and quality of life. Chance of Reduced Discrimination in the Future? The majority of Americans believe that health insurance should cover weight loss surgery, in addition to other obesity treatments such as dietetic and mental health counseling. The Affordable Care Act (“Obamacare”), though, is not the ultimate solution. In nearly half of states, obesity treatments are not required to be covered by plans sold on the health exchanges. This determination is based on the available competitive services in the region. Since the most obese states are the ones least likely to have competitive anti-obesity care, these states are also least likely to have obesity treatments covered under the Affordable Care Act. Overcome the Discrimination Discrimination is an unfair fact of life as an obese individual, and it unfortunately does not end when you decide to get healthy using weight loss surgery as a tool. These are some of the ways that you can keep going strong and overcome the barriers you encounter as you work to get healthy. You have the right to a second opinion if your primary care physician recommends against weight loss surgery but you would like to find out more. Do not take “no” for an answer from your insurance company if you know you are entitled to reimbursement for surgery. Do not listen to negative family members or friends who do not understand your obesity or interest in weight loss surgery. It is your life and health. Educate others as much as you can to try to reduce the discrimination. Chances are that they are only being discriminatory out of ignorance, not out of true mean-spiritedness. Like it or not, some discrimination remains as you go through your weight loss journey. You cannot prevent it, but you can change how you react to it. Expect it and respond as positively as you can, keeping your own health and goals in mind. Over time, as you and others prove that weight loss surgery can be a worthwhile treatment for obesity, discrimination by insurance companies, healthcare providers, and the public will decrease.

As a weight loss surgery patient, you have to decide whether to tell others about your weight loss surgery. Should you come out of the “weight loss surgery closet” and tell others about your weight loss surgery? Whom should you tell? What should you say? How much should you talk about? There’s no single right answer to these questions. The right thing for you to do is whatever makes you most comfortable. Some people tell everyone everything. They want to share their experiences to try to help others, to get people to understand what they are going through, and to show that they are proud of their actions towards a healthier lifestyle. Some people tell their closest family members and friends most things, and tell more distant acquaintances only the basics or nothing. They might think of weight loss surgery as a medical issue that you don’t talk about in public indiscriminately. Some people tell others on a “need to know” basis. People who “need to know” are often household members and close friends. Other people whom you feel “need to know” may be individuals who themselves are fighting with obesity and therefore might benefit from hearing your story. Some people keep it as quiet as possible. They feel that the only reaction they’ll get is a negative one; that uninformed people will judge them for “taking the easy way out;” and that they’ll just feel bad about themselves. Getting Rid of Society’s Weight Loss Surgery Stigma Imagine that you, a weight loss surgery patient named “Jane,” are part of the following conversation. Person A: Hi, guys! Great to see you! How are you? Person B: Hey! I’m doing well, thanks. How are you? Have you been able to get any help for your depression? Person A: Yes, thanks! I’ve found a great therapist and been on some medications, and they’re really helping. How about your diabetes? How has your blood sugar been? Person B: Oh, it’s okay. I’m taking my meds and really watching my carbs. Most days, my blood sugar is right in range. How are you doing, Jane? You (Jane): Oh, fine, thanks. You know, same old. Work is good, and the family is doing well, so can’t complain. The conversation is okay, but shouldn’t you be able to feel just as comfortable talking about your weight loss surgery and new lifestyle as your friends do talking about their mental health and treatment, and their diabetes medications and diet? Nobody bats an eyelash when discussing prescription medications, mental health, and diets. Wouldn’t it be refreshing for a conversation that goes more like the following to be the norm? Person A: Hi, guys! Great to see you! How are you? Person B: Hey! I’m doing well, thanks. How are you? Have you been able to get any help for your depression? Person A: Yes, thanks! I’ve found a great therapist and been on some medications, and they’re really helping. How about your diabetes? How has your blood sugar been? Person B: Oh, it’s okay. I’m taking my meds and really watching my carbs. Most days, my blood sugar is right in range. How are you doing, Jane? You (Jane): Great, thanks! The gastric bypass surgery three months ago was pretty rough, but things are on the right track now. I’ve been super careful with my diet, and I think I will finally be able to lose a little weight! How can weight loss surgery become part of the mainstream conversation? How can we reduce the stigma surrounding obesity and weight loss surgery, just like we have thankfully made a lot of progress reducing the stigma surrounding cancer, mental disorders, HIV/AIDS, and many, many other diseases. Why does the stigma around obesity – and particularly weight loss surgery – remain? Among the many possible reasons is the lack of information. Most people don’t know: How many times you have tried and failed to lose the weight long-term. What weight loss surgery is, and the number of different kinds there are. That the surgery itself does not make you instantly lose weight. How hard you have to work to lose weight after surgery by following a very careful and restricted diet. Coming out of the weight loss surgery closet is a movement. It becomes easier when more people do it. Eventually, weight loss surgery can become an accepted and respected action and topic of conversation. We’re making some progress. Over the past few years, several celebrities have gotten weight loss surgery procedures and allowed them to become public. The View host Star Jones Reynolds Television host Sharon Osbourne Comedian Lisa Lampanelli NFL Jets coach Rex Ryan Actor Brian Dennehy Wilson Phillips singer Carnie Wilson Heart vocalist Ann Wilson Comedian and television star Roseanne Barr New Jersey governor Chris Christie American Idol judge Randy Jackson Weather forecaster Al Roker Singer Patti Austin Chef Graham Elliot Author Anne Rice Musician John Popper Singer Etta James What to Do When You Decide to “Come Out” Let’s say you decide that you’re ready to come out of the WLS closet. “The Talk” with your friends and family members can be planned. Practice what you’ll say so that it comes out easily and naturally when you’re ready to say it. Keep it simple. Most people don’t know what a sleeve plication is, or the difference between gastric bypass or lap-band. Start by telling them that you got a type of weight loss surgery, and provide details if they seem interested. Be ready for questions. They might wonder what kind of diet you follow, how your stomach feels, whether you have to give up lots of foods, and all sorts of things that may seem basic to you. Be patient with them and answer their questions. It’s okay to set boundaries. If you don’t feel comfortable talking about dumping syndrome or measuring your food, you don’t have to. Coming out to other acquaintances might be more spontaneous. The conversation with a work colleague might start with something like, “Hey, how come you never come out to lunch with us anymore?” That’s your chance to answer, “I really miss going out with all of you, but I got weight loss surgery a few months ago. I can’t eat that kind of food on my new diet.”

You’re well on your way to getting lap-band surgery by the time you choose a surgeon and figure out how to pay for it, as you learned about in Chapter 5, “Planning Your Lap-Band Surgery” in The BIG Book on the LAP-BAND. Chapter 6, “Preparing for Surgery and the Hospital,” has details about what you will do to get ready for the actual surgery. Pre-Surgery Medical Care A lot of preparation is necessary before you can get banded. You’ll have medical tests and appointments, and have to follow a pre-surgery diet. You’ll learn more about the procedure and what to expect afterward as you recover from surgeon and lose weight. Surgeon Appointments You’ll have one or more pre-surgery appointments with your surgeon. Each appointment is an opportunity to ask questions, such as details about the lap-band procedure, what happens if you develop complications and any other concerns. Be sure to bring up any known medical conditions that you have so your surgeon can be prepared. You and your surgeon will set your surgery date, which can be several months ahead. Use your pre-surgery appointment(s) to decide whether you are sure that you have made the right choices regarding getting the lap-band and choosing a particular surgeon. Medical and Psychiatric Tests You’ll get a battery of tests to make sure you’re healthy enough for the surgery. These might include an abdominal ultrasound to make sure that your physiology is normal, an EKG to assess your heart beat, blood tests to evaluate your nutritional status and lung, liver and kidney function and chest and gastrointestinal x-rays. You’ll have a psychological evaluation to make sure you do not have any untreated psychological conditions that can interfere with your success with the lap-band. Dietitian Meetings and Pre-Surgery Liquid Diet You will meet with a dietitian to make sure you understand the lap-band diet that you will be following for years after surgery. The diet will help you lose weight and keep the weight off. The dietitian may assess your current diet and point out changes that will occur on the lap-band diet. In addition, the dietitian will guide you in a pre-surgery weight loss diet, if your insurance policy requires it before reimbursing your surgery, and in a pre-surgery liquid diet in the days leading up to surgery. The liquid diet lasts for 5 to 14 days before surgery and consists of liquids, with no solid foods. It helps shrink your liver to make your surgeon’s job easier. You may get to have protein shakes and other liquids on this diet, but not sugary liquids and soft drinks. Final Preparations for Surgery A few things to take care of as your surgery approaches are getting time off from work, making sure you have a ride home from the hospital and, if you are going to Mexico for the procedure, getting your passport in order. You can prepare your home by stocking your kitchen with the liquids and foods that you’ll need after surgery, since you might not feel like going grocery shopping right after your surgery! Pain medications should be available, but make sure that your surgeon approves them and gives you directions for using them. High doses of common pain medications, such as aspirin and ibuprofen, can lead to lap-band complications such as erosion. You probably just need a small overnight bag for the hospital. It’s a good idea to be prepared to stay overnight, even if you’re scheduled to be released the same day, just in case there are complications. These are some of the items to pack: (Wear loose-fitting clothes) a change of underwear simple toiletries: toothbrush, toothpaste, lotion, hand sanitizer, comb book, magazine, iPod or another form of entertainment important papers: insurance papers and phone numbers cell phone (fully charged) medications and dietary supplements Chapter 6, “Preparing for Surgery and the Hospital,” in The BIG Book on the LAP-BAND has more details about what to bring, what not to bring and what to bring to Mexico. By the time you’re done with all of these steps, it’ll be time for your surgery! This is the easiest part of the whole lap-band journey. All you have to do is get to the hospital and check in. From there, the nurses and staff will take care of you. You will get wheeled into the surgery room, lie down on a table and receive anesthesia. You’ll have the lap-band inside of you the next time you wake up.

Great article Jean! Thanks as always for your great contribution.

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